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International Journal of Applied Dental Sciences 2021; 7(2): 102-105

ISSN Print: 2394-7489

ISSN Online: 2394-7497

IJADS 2021; 7(2): 102-105

© 2021 IJADS

www.oraljournal.com

Received: 19-01-2021

Accepted: 21-02-2021

Dr. Mounika Ayinala

Postgraduate Student,

Department of Prosthodontics,

Rajarajeswari Dental College

and Hospital, Bangalore,

Karnataka, India

Dr. Shwetha Poovani

Professor, Department of

Prosthodontics, Rajarajeswari

Dental College and Hospital,

Bangalore, Karnataka, India

Dr. Gautam Shetty

Head of the Department,

Department of Prosthodontics,

Rajarajeswari Dental College

and Hospital, Bangalore,

Karnataka, India

Dr. Shreya Bukkapatnam

Senior Lecturer, Department of

Prosthodontics, Rajarajeswari

Dental College and Hospital,

Bangalore, Karnataka, India

Corresponding Author:

Dr. Mounika Ayinala

Postgraduate Student,

Department of Prosthodontics,

Rajarajeswari Dental College

and Hospital, Bangalore,

Karnataka, India

Enhancing patient’s esthetics through complete

denture: An amalgamation of techniques

Dr. Mounika Ayinala, Dr. Shwetha Poovani, Dr. Gautam Shetty and

Dr. Shreya Bukkapatnam

DOI: https://doi.org/10.22271/oral.2021.v7.i2b.1196

Abstract Every human being aspires to look beautiful and will continue to do so even when the odds are against

them as they get older. Nowadays almost every edentulous patient demands a lot on the esthetics front, at

least with hope for having to overcome their sunken/hollow cheek, for that slight bit of joy having to

reminisce their past, when they were young and beautiful. By the use of the maxillary cheek plumpers,

some support can be provided to the cheek and thereby the esthetics as well, but having to do so will be

at the cost of the discomfort which the patient endures due to its added weight. This article describes the

combination of Hollow Denture along with Cheek Plumper techniques, to provide more comfort to the

patients, while it being non-invasive & cost-effective for the benefit of all kinds of people, as it is within

every person’s rights to look wrinkleless & attractive.

Clinical Implication: This technique enables the elderly and those with poor manual dexterity by

completely removing any effort which needs to be put in as there is no need for attachments & enhancing

the facial esthetics while remaining cost-effective. It is a quick non-invasive procedure to provide better

esthetics to the discouraged/discomfiture patients, without causing much difficulty in usage on a day to

day life.

Keywords: hollow denture, cheek plumper, complete denture, facial esthetics

Introduction

One of the main objectives of a removable complete denture is to benefit the patients with the

process of deglutition/ improve their masticatory efficiency. Fabrication of this complete

denture is unique for every patient and it cannot be limited to any specific procedure. Often,

patients are concerned about their facial esthetics to maintain their professional and social

relationships and retain their self-confidence [1]. Due to the loss of dentition, alveolar ridge

resorption, and soft tissue changes; concavities are noticed below the malar prominence

producing sunken/ hollow cheek appearance. In the past, various surgical treatments were

carried out for providing adequate facelifts using implants, but those procedures are invasive

and time-consuming [2]. To overcome those disadvantages, simpler approaches had been

described such as the use of cheek plumpers [3, 4].

Typically, cheek plumper comes as a single-unit prosthesis which extends anteroposterior and

mediolaterally from premolar to molar region to provide support to the cheeks. They provide a

feeling of fullness to the mouth while it contours the patient’s mouth by being an integral part

of the maxillary/mandibular prosthesis. However, it tends to add more weight to the denture

and thereby on the residual alveolar ridges, leading to poor retention of the prosthesis [5, 6].

Hollow denture technique on the other hand is known for its light-weighted dentures and is

usually given to the patients where the load on the residual alveolar ridges is significantly

lighter, thereby making the patients feel more comfortable.

This article describes the combination of Hollow Denture along with Cheek Plumper

techniques, to provide more comfort to the patients, while remaining non-invasive & cost-

effective, to benefit the most on contributing towards patient’s esthetics.

Clinical Report

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International Journal of Applied Dental Sciences http://www.oraljournal.com A 78-year-old female

sought care at the Dental

College and Hospital with a chief complaint of missing teeth and requested for the replacement

of the same.

On extraoral examination, there was wrinkling of the skin,

loss of resiliency of facial muscles, and hollowing of cheeks

as shown in figure 1. Intraoral examination revealed

completely edentulous upper and lower arches. The patient

gave a history of mobile teeth that were extracted in the past 1

year and was completely edentulous for 3 months. Upon

revealing the above-made observations to the patient, the

patient desired a prosthesis which would improve the

masticatory function and ultimately provide a healthier look.

Diagnostic/primary impressions of maxillary and mandibular

arches were made using impression compound (pinnacle

impression compound, dental products of India) which were

poured in dental plaster. Custom trays were fabricated using

auto-polymerizing resin for carrying out border molding and

secondary impression procedures using low fusing impression

compound & light body addition silicone impression material

respectively. Maxillo mandibular relationship was established

following the facebow transfer to orient the maxilla to the

cranium as shown in figure 2. During the try-in appointment,

waxed up denture was first tried on the patient to verify the

centric occlusion. To provide a fuller appearance of face for

the patient, additional modeling wax strips were added on the

maxillary denture on the right and left side from the distal end

of canine to the molar region which was further evaluated to

check for symmetry as shown in figure 3.

Steps for the fabrication of Hollow Denture with Cheek

Plumper (After try-in):

1. Measure the thickness for the modeling wax from the

base plate, by using an endodontic file with a rubber stop

as shown in figure 4a.

2. The thickness of the adapted wax is about 10mm as

shown in figure 4b.

3. Duplicate the maxillary master cast using irreversible

impression material. Adapt a sheet of 2mm thickness

modeling wax and invest it into the flask by conventional

compression molding technique as shown in figure 5.

After dewaxing, apply a tin foil substitute and pack the

heat polymerizing acrylic resin into the mold space.

4. Retrieve the final heat cure denture base from the flask,

trim and polish it.

5. Meanwhile, invest the trail dentures and post dewaxing,

place the polished denture base plate on the cast and

check for the proper closure of both the components as

shown in figure 6. Look for any gap, trim, and adjust the

denture base to ensure proper closure of the flask.

6. Following this, mix silicone putty and roll it along its

length maintaining a thickness of 8mm. Attach it to the

polished denture base from the distal end of canine to the

molar region on the right and left side and secure it using

a cyanoacrylate as shown in figure 7a.

7. Adapt heat polymerizing acrylic resin to the plaster mold

containing prosthetic teeth. Thereafter, carry out the

conventional process of bench curing and cooling.

8. Retrieve the maxillary and mandibular dentures from the

flasks as shown in figure 7b and remount it on the semi-

adjustable articulator to adjust the occlusion. Drill a hole

of 5 mm in diameter distobuccal to the most posterior

teeth in the maxillary denture as shown in figure 8.

9. Use a tweezer to pull out the silicone putty roll on both

sides and finish & polish the dentures in the usual manner

to seal the openings using auto-polymerizing acrylic resin

as shown in figure 9.

10. Check the denture for adequate seal and then deliver it to

the patient as shown in figure 10.

Discussion

Various methods of hollowing maxillary/mandibular dentures

were proposed in the past by several authors by using gelatin

mix, polystyrene (thermocol pieces) and silicone putty [7-10].

Every technique has its pros and cons. This innovative

technique does not make use of the procedures indicated for

hollow denture techniques like clear, pressure formed matrix

during the trial stage to minimize the laboratory procedures,

and the use of endodontic file aided in evaluating the

thickness of silicone putty to be added to the base plate.

Usually, upon sealing the openings made in the denture for

retrieval of silicone putty with auto-polymerizing resin, it

tends to have a seepage. However, there was no seepage

observed at the closure of the hole (openings made for

silicone putty retrieval) despite it being too small in

dimension.

Typically, facial esthetics enhanced using the cheek plumpers

are fabricated with numerous attachments such as magnets,

press stud fasteners, double die pins, friction lock, customized

castable attachments.11-15 There could be a possibility for

swallowing the attachment while aspirating or during the

consumption of food as they are too small and thereby putting

the patients at risk. Patients with poor manual dexterity would

find it difficult to use these detachable prostheses due to the

tedious procedures involved and might have to endure the

discomfort caused by the added weight on the prosthesis.

The procedure described in this article overcomes the cons

faced by the use of generic cheek plumper, while being

inexpensive with no further lab equipment needed in the

fabrication of the complete denture and eliminates the

breakage of any attachments or corrosion of any magnets,

without the need for any additional maintenance.

This particular patient suffered from poor neuromuscular

control and had remained edentulous for a long time. In such

situations, where there are sunken cheeks and broad denture

bearing area, the technique described in this article can be

utilized for fabrication of complete denture with cheek

plumpers, as conventional dentures along with typical cheek

plumper would add weight to the prosthesis.

The planning of complete denture was slightly altered for the

benefit of the patient to provide better ease, by delivering a

weightless prosthesis with the buccal bulge to compensate for

the sunken cheeks. The concept of cheek plumper with hollow

denture was combined in this contemporary design, thereby

achieving this technique in a straight forward, non-invasive,

and cost-effective way.

From the time of delivery of the prosthesis, the patient was

recalled thrice within 6 months to re-evaluate the dentures.

The patient did not complain of any discomfort with the

prosthesis either during speech or mastication and her

bystanders were pleased to notice the esthetic outcome of the

treatment.

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International Journal of Applied Dental Sciences http://www.oraljournal.com

Fig 1: Extraoral view- frontal and lateral

Fig 2: Facebow transfer

Fig 3: Waxed up dentures

Fig 4a: Endodontic file used to measure thickness

Fig 4b: Thickness of adapted wax was 10mm

Fig 5: 2mm thickness modelling wax adapted

Fig 6: Post dewaxing, adaptation of denture base

\

Fig 7a: Attachment of silicone putty to denture base and packing

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International Journal of Applied Dental Sciences http://www.oraljournal.com

Fig 7b: Retrieval of dentures after acrylization

Fig 8: Opening of 5mm diameter

Fig 9: Finished and polished dentures

Fig 10: Extraoral frontal view

Conclusion

Adequate support to the cheeks has been provided to improve

the overall appearance of the patient's face. The technique

described in this article for the fabrication of complete

dentures by incorporating a bugle can bring down the weight

of the prosthesis, thereby redefining the esthesis of the

patients. Usually, patients get psychologically affected

because of sunken cheeks but restoring the contour of the face

through this technique helps such patients in regaining their

confidence and also enables the elderly without any difficulty

in usage on a day to day life.

References

1. Krajicek DD. Achieving realism with complete dentures.

J Prosthet Dent 1963;13:229-35.

2. Bains JW, Elia JP. The role of facial skeletal

augmentation and dental restoration in facial

rejuvenation. Aesthetic Plast Surg 1994;18:243-6.

3. Lazzari JB. Intraoral splint for support of the lip in Bell's

palsy. J Prosthet Dent 1955;5:579-81.

4. Larsen SJ, Carter JF, Abrahamian HA. Prosthetic support

for unilateral facial paralysis. J Prosthet Dent

1976;35:192-201.

5. Keni NN, Aras MA, Chitre V. Customised attachments

retained cheek plumper prosthesis: A case report. J Indian

Prosthodont Soc 2012;12:198-200.

6. Virdiya NM, Palaskar JN, Wankhade J, Joshi N.

Detachable cheek plumpers with different attachments

for improving esthetics in a conventional complete

denture: A clinical report. J Prosthet Dent 2017;117:592-

6.

7. Deogade SC, Patel A, Mantri SS. An alternative

technique for hollowing maxillary complete denture. J

Indian Prosthodont Soc 2016;16:412.

8. Shetty V, Gali S, Ravindran S. Light weight maxillary

complete denture: A case report using a simplified

technique with thermocol. J Interdiscip Dent 2011;1:45.

9. O'Sullivan M, Hansen N, Cronin RJ, Cagna DR. The

hollow maxillary complete denture: A modified

technique. J Prosthet Dent 2004;91:591-4.

10. Radke U, Mundhe D. Hollow maxillary complete

denture. J Indian Prosthodont Soc 2011;11:246-9.

11. Punia V, Mishra R, Khandelwal M, Verma N, Handa M.

Magnet retained detachable cheek plumper: innovation

personified-a case report. Int J Prosthet Dent 2013;4:16-

20.

12. Kamakshi V, Anehosur GV, Nadiger RK. Magnet

retained cheek plumper to enhance denture esthetics: case

reports. J Indian Prosthodont Soc 2013;13:378-81.

13. Deogade SC. Magnet retained cheek plumper in complete

denture esthetics: a case report. J Dent (Tehran)

2014;11:100-5.

14. Bhushan P, Aras MA, Coutinho I, Rajagopal P, Mysore

AR, Kumar S. Customized cheek plumper with friction

lock attachment for a completely edentulous patient to

enhance esthetics: a clinical report. J Prosthodont

2019;28:e1-5.

15. Pudi S, Kota S, Ch KK, Kaladi SR, Gade RR. An

Innovative Technique Using a Stainless Steel Double Die

Pin Retained Cheek Plumper in Complete Denture

Esthetics: A Case Report. Cureus 2019;11:1-8.